- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.00 / $1,728.00 / $2,639.00
| Facility | | $1,080.00 | $1,728.00 | $2,639.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,474.79 / $1,474.79 / $1,474.79
| Facility | 54 | $1,474.79 | $1,474.79 | $1,474.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.16 / $5,530.12 / $7,439.78
| Facility | | $4,568.16 | $5,530.12 | $7,439.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,852.23 / $8,295.17 / $11,159.67
| Facility | 50 | $6,852.23 | $8,295.17 | $11,159.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,121.00 / $7,227.00
| Facility | | $1,485.00 | $4,121.00 | $7,227.00 |